Canadian Journal of Cardiology

Positive Recommendation for Angiotensin Receptor–Neprilysin Inhibitor: First Medication Approval for Heart Failure Without Reduced Ejection Fraction

  • Jonathan G. Howlett
    Corresponding author: Dr Jonathan G. Howlett, Room C-838, 1403 29th Street NW, Calgary, Alberta T2N 2T9, Canada. Phone: +1-403-944-3232; fax: +1-403-944-3262.
    Division of Cardiology, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Published:January 19, 2021DOI:
      Heart failure (HF) is a problem of epidemic proportions in Western societies; it is a major public health burden and source of morbidity and mortality. Traditionally, HF has been categorised according to left ventricular systolic function. Patients with heart failure and left ventricular ejection fraction (LVEF) < 40% have been referred to as having HF with reduced ejection fraction (HFrEF), and those with higher LVEF as having HF with preserved ejection fraction (HFpEF). Although these two HF types are quite similar in terms of clinical presentation, rate of hospitalisation, quality of life, and symptom and caregiver burdens, fundamental differences remain.
      • Boulet J.
      • Massie E.
      • Rouleau J.L.
      Heart failure with midrange ejection fraction—what is it, if anything?.
      Unlike HFrEF, for which 6 approved medication classes exist for treatment to reduce CV mortality, there are no approved therapies for the nearly 300,000 patients with HFpEF in Canada. In addition, HFpEF is increasingly common and is responsible for approximately 50% of prevalent HF and for 75,000 annual hospitalisations in Canada. This has resulted in a large unmet clinical need for patients affected by HFpEF.
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